“…Research should encompass whether ongoing training and assessment is able to change the practice habits of seasoned practitioners or if an emphasis on cricoid pressure technique is better received and retained during the initial clinical education years. Although the incidence of passive aspiration during emergency airway management in patients at high risk for aspiration is already low, it would be valuable to know whether the incidence can be further decreased with standardized information and practical skill.♦Cricoid pressure (ie, the Sellick maneuver) is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. The procedure is used to occlude the esophagus, preventing the aspiration of gastric contents during the induction of anesthesia and during the resuscitation of emergency victims when intubation is delayed or not possible.♦Ongoing controversy exists regarding whether this maneuver should be used and how effective it is in decreasing morbidity and mortality.…”
We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. We appraised the included studies using standardized tools validated for this purpose and we performed a meta-analysis of the eight eligible studies. The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.
“…Research should encompass whether ongoing training and assessment is able to change the practice habits of seasoned practitioners or if an emphasis on cricoid pressure technique is better received and retained during the initial clinical education years. Although the incidence of passive aspiration during emergency airway management in patients at high risk for aspiration is already low, it would be valuable to know whether the incidence can be further decreased with standardized information and practical skill.♦Cricoid pressure (ie, the Sellick maneuver) is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. The procedure is used to occlude the esophagus, preventing the aspiration of gastric contents during the induction of anesthesia and during the resuscitation of emergency victims when intubation is delayed or not possible.♦Ongoing controversy exists regarding whether this maneuver should be used and how effective it is in decreasing morbidity and mortality.…”
We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. We appraised the included studies using standardized tools validated for this purpose and we performed a meta-analysis of the eight eligible studies. The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.
Application of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a “standard” of care for many decades, despite limited scientific proof of its efficacy in preventing pulmonary aspiration of gastric contents. While some of the current rapid sequence induction and intubation guidelines recommend its use, other international guidelines do not, and many clinicians argue that there is insufficient evidence to either continue or abandon its use. Recently published articles and accompanying editorials have reignited the debate on the efficacy and safety of CP application and have generated multiple responses that pointed out the various (and significant) limitations of the available evidence. Thus, a critical discussion of available data must be undertaken before making a final clinical decision on such an important patient safety issue. In this review, the authors will take an objective look at the available scientific evidence about the effectiveness and safety of CP in patients at risk of pulmonary aspiration of gastric contents. We suggest that current data are inadequate to impose clinical guidelines on the use of CP because we acknowledge that currently there is not, and there may never be, a method to prevent aspiration in all patients. In addition, we reiterate that a universally accepted medical-legal standard for approaching the high-risk aspiration patient does not exist, discuss the differences in practice between the US and international practitioners regarding use of CP, and propose 5 recommendations on how future studies might be designed to obtain optimal scientific evidence about the effectiveness and safety of CP in patients at risk for pulmonary aspiration.
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